Chaplain DW Donovan on the limits of volunteer chaplaincy

A Response to Volunteer Chaplains – Yes or No

I hope it’s not too late to add my two cents on the issue raised by Marshall Scott in his article entitled “Volunteer Chaplains – Yes or No.” (PlainViews, Vol. 3, No. 14, 8/16/2006)

The fact that I’m so far behind in my reading might suggest that additional staffing in our pastoral care department would be welcome … but I have to agree with those who have argued that such help should not come in the form of volunteer chaplains.

Chaplain Scott begins by describing a model of nursing that has evolved towards less and less hands-on care by nurses, and suggests that practitioners with a lower level of training, including volunteers, now engage in many nursing functions.

I would challenge this premise. The functions he describes, such as passing ice water and distributing literature, are not truly nursing functions. In today’s era, marked by pressure to reduce length-of-stay, patients who do not require true nursing care are sent home. Today’s nurse is a true medical professional, charged with assessing the medical needs of the patient (this is not just a role for doctors) and helping to coordinate their overall care.

While I appreciate the dedication exhibited by those who have cared for loved ones at home, I’m always a bit perturbed when they make an offhand comment that they have “earned their nursing degree” through their work at home. In that same way, years of visiting family members, even church members in the hospital, does not a chaplain make. Just as there is a gold standard in terms of education and peer review (passing one’s boards) in order to claim the title of Registered Nurse, we are moving towards that same level of professionalism in pastoral care.

I would agree that the board-certified chaplain is an advanced practitioner. However, the context of our ministry is not as an extension of church life, but can best be understood as an integral part of the healthcare team.

Considered from this perspective, the staffing of pastoral care departments must be based on the assessed needs of the patients and families. In my department, we have defined the role of the clinically trained chaplain in this way: to assess the degree to which the patient's emotional and spiritual equilibrium has been disturbed by the healthcare event and to determine what interventions would be appropriate to help the patient restore his or her equilibrium and when such interventions should be employed.

If we are serious about providing pastoral care as an integrated part of healthcare (and not everyone is, although I’m grateful to JCAHO and JCAPS for their work in this direction), then we have to ask what training is sufficient to meet the identified needs of our patients and families. Over the years, and for very good reasons, four units of Clinical Pastoral Education, together with a masters degree, has become the gold standard for chaplaincy. I am even leery of Chaplain Cathell’s suggestion (Responses to Volunteer Chaplains – TalkBack, Vol. 3 no. 15) of creating a satellite CPE program to meet the needs of patients. The entire point of a CPE program is to train ministers to be chaplains, not to provide inexpensive pastoral care coverage.

Likewise, while I’m delighted that my friend and colleague Chaplain John Stangle first came into contact with professional chaplaincy through volunteer work, there is a reason for the additional training … one needs it in order to be effective. In a similar vein, I would respond to Chaplain Ramos’ invitation that we take volunteer chaplains and train them to be the best by acknowledging my own limitations: I am not a teacher. I am certainly not a CPE supervisor, and I’m not qualified (nor do I have the time) to turn volunteers into chaplains. We have a program to develop chaplains and it works very well. We need to use it, and continue to affirm the “gold standard” of competency-based board certification.

Once hired, we must live or die on our own merits. To quote my mentor, administrators are not deaf to the work we do. Given the opportunity to see truly effective pastoral care, administrators are able to see “who cooks the best vegetables.” If you yourself are in doubt, move into the literature and note how unit-based, clinically trained pastoral care can make a difference in measurable areas such as length-of-stay and patient satisfaction. You might even surprise yourself.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.